Please note that all applications will be accepted on a first come-first serve basis. HOWEVER, the Enrichment Program will not be available to students who receive a mandatory notification letter for Summer Academy BRIDGE Program or Summer Academy RECOVERY Program, as all programs occur simultaneously.

Student #3's means of transportation to Summer Academy (select all that apply):
*

Metro Bus Metro Rail Parent Drop Off Parent Pick Up

Parent/Guardian Name:
*

First Name Last Name

Parent/Guardian Email Address:
*

Parent/Guardian Phone Number:
*

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Area Code Phone Number

Is this a cell phone number?
*

Yes No

Would you like to add an additional Parent/Guardian's information?
*

Yes No

Parent/Guardian #2 Name:

First Name Last Name

Parent/Guardian #2 Email Address:

Parent/Guardian #2 Phone Number:

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Area Code Phone Number

Is this a cell phone number?

Yes No

Emergency Contact Name:
*

First Name Last Name

Emergency Contact Email Address:
*

Emergency Contact Phone Number:
*

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Area Code Phone Number

Would you like to add an additional Emergency Contact's information?
*

Yes No

Emergency Contact #2 Name:
*

First Name Last Name

Emergency Contact #2 Email Address:
*

Emergency Contact #2 Phone Number:
*

-
Area Code Phone Number

Is this a cell phone number?
*

Yes No

By entering my full name below, I certify that my answers are true and complete to the best of my knowledge. I understand that false or misleading information in my application may result in the student listed above not being admitted into the 2012 Summer Academy Enrichment Program.